What I did to reduce the risk of Long COVID after getting COVID
I recently got COVID for the first time, and I thought it might be of interest for me to share the measures I took to reduce my risk of getting Long COVID.
I have no scientific or medical training, and this is not medical advice to you—consider it a starting point for your own research and sense-checking.
I’d welcome input on any or all of it, especially guidance on how to approach a return to pre-COVID levels of physical activity. (If you want to discuss the risk of long COVID, though, better to do that on a post dedicated to that topic—the most recent one seems to be this.)
Why care about long COVID?
My current assessment is that meaningful long-term impairment from COVID is not very common (otherwise I’d be hearing a lot more about it anecdotally), but nor is it trivially unlikely—a Jan 2023 Nature Reviews Microbiology article cities two 2022 studies (covering about 40,000 patients in total) to estimate the incidence at 10-12% of vaccinated cases, whereas a Dec 2022 post by Your Local Epidemiologist looked at a few larger studies and came out with a 3% estimate—potentially an underestimate, based on discussion in comments . I haven’t tried to reconcile any of those studies to see where they shake out, but the point is the incidence seems non-trivial.
Anecdotally, a friend of mine who is one of the healthiest people I know (doesn’t drink, exercises regularly, spent an extended period of time wearing a continuous glucose monitor and optimizing his diet accordingly, despite being nowhere close to prediabetic, etc.) recently shared that he is experiencing moderately troublesome long COVID despite a similarly mild case initially, so that makes the prospect more vivid in my mind.
Measures I took after getting COVID
I’m a fairly healthy guy (normal BMI, exercise a bit ~5-6x a week, mild to maybe moderate asthma) in my mid-30s
I had a pretty mild case of acute COVID—I had significant fatigue (I slept ~10-12 hours a day compared to my usual 7h during the workweek and 9h on weekends), very mild body ache for the first day or two, and minor congestion / cough until I started testing negative. So while many of the measures I took are also helpful for managing the severity during the acute phase of COVID, my main goal was to minimize my risk of long COVID
I have no medical or scientific background, and probably average or below-average numeracy/epistemics compared to the average LessWrong reader, though I have reasonably strong attention to detail and logical reasoning skills generally. I did not attempt to closely read or independently analyze the validity of any of the studies cited as sources below.
What: As soon as I tested positive, I messaged my primary care practice and asked for Paxlovid to reduce long COVID risk. I claimed moderate-severity asthma as a qualifying factor even though my asthma is arguably more on the mild side than moderate). They (One Medical, in my case) readily agreed to prescribe.
Why: a large study found that Paxlovid reduced incidence of long COVID by 26%, regardless of vaccination status and history of prior infection
The study was in older / higher-risk populations, but there is reason to believe that it would help with younger / lower-risk populations as well (YLE actually thinks it would have greater effect for younger people for reasons she doesn’t explain)
It did leave a metallic taste in my mouth (even after I rinsed), but no worse than eating a bitter grapefruit, and rinsing / drinking water / eating things eliminated the taste for at least 5-10 min each time.
Things that didn’t bother me:
From Googling and talking to my primary care, I found no significant risk of side effects (or contraindications with my other meds). Note that it does have several drug interactions, so you make sure whoever is prescribing it to you is fully aware of all the medications and supplements you are taking)
There’s been talk of “Paxlovid rebound”, but the FDA recently found that people rebound at a comparable rate without Paxlovid. (Another source I read recently, analyzing other studies which had found a rebound rate on the order of 5-10% (if I recall correctly), speculated the earlier findings may be because people were tracking rebound more closely with Paxlovid.) In any case, I recall reading (I believe from Eric Topol) that most rebounds are less less severe than the initial case.
How to get it:
If your PCP won’t prescribe it for reasons you disagree with, or you can’t get ahold of them in time:
For folks based in CA, a friend who just got COVID suggested calling the statewide COVID-19 hotline at 833-422-4255. Ask for treatment options and ask for a tele-health appointment. She was able to get a prescription in less than 30 minutes after calling, vs. her primary care which was going to take much longer.
Otherwise, someone I’m forgetting posted about a year ago that Plushcare also is a good source for getting a prescription.
What: I asked my PCP to prescribe me metformin to reduce long COVID risk. He agreed to prescribe it so I could replicate the (2-week) regimen in a recent RCT.
Why: a large RCT found that metformin reduced long COVID risk by 42% vs. placebo, 63% if taken within 4 days of symptoms.
It can cause nausea or diarrhea; I seem to have avoided this by taking it with meals, but I do think it has caused a degree of indigestion
It does have drug interactions
If you drink too much alcohol while on it, it can lead to hypoglycemia, which is bad for you / dangerous. My PCP advised me to completely abstain from alcohol while I’m on it, which I’m fine with.
Sleep: I got as much sleep as I felt I needed to feel reasonably ok. If I was tired during the day, I napped instead of drinking more caffeine to power through.
I’ve still been getting 9h of sleep a night even after I started testing negative, because I need it in order to feel reasonably good. I plan to do so until that changes, as I’ve read a lot to suggest that it’s important to rest after the acute phase.
Mental rest: I didn’t try to push myself to do work or be productive, although I did join a few meetings and join a few emails here and there.
Physical activity: I took a few very short, slow walks during the acute phase, but listened to my body and stopped when I was tired. (The primary care doc who prescribed my Paxlovid said a gentle walk was ok during the acute phase if I felt up to it, but that I should avoid walking more than a mile, and cautioned that exercise is generally a stressor and rest is important).
Even now that I am testing negative, I’m holding off on anything beyond a gentle walk until my lingering symptoms (at this point, just tiredness) are completely gone, at the advice of a researcher leading a major research project on long COVID.
I’d particularly welcome any further insight on this, as there isn’t much written on it and I’d really like to get back to higher tempo partner dancing again in particular!
Cold showers: I typically end a ~5 min hot shower with ~60 sec of ice cold water in the mornings because it makes me feel energized and peaceful. I haven’t found anything written on this either way, but it intuitively feels like it’s somewhat stressful on my body, so I’m holding off until all lingering symptoms are gone.
A friend shared a detailed COVID guide by Chris Masterjohn (updated Aug 2022). He has a PhD in nutritional science and the guide is rather detailed, with references to studies for all its claims. From glancing at the studies many of them seemed to be small / not very robust studies.
I bounced these off the primary care practitioner who prescribed me the Paxlovid; for the ones where she expressed concern or doubts, I Googled side effects and interactions and the generally recommended daily upper limit, and took them anyway (none of her concerns seemed especially grave).
His guide goes into more detail on the specific types / brands of these to get in certain instances; if you do plan to proceed with this it’s worth the $10 to buy it. Not all of these will be available within a day on Amazon / from local pharmacies, so if you’re serious about this, stock up in advance.
Here are his recommendations I followed:
IMPORTANT: I seem to recall there may be some instances where the safe upper limit varies between men and women. Please double check that for yourself if you’re a woman. Also check if any of these have interactions with anything you’re taking.
Zinc acetate: suck on 30-50 mg lozenge every 2h
Copper: 4-8 mg/day
Vitamin D3: I just stuck with my usual dose of 2500 IU daily.
Masterjohn recommends 100,000 IU the first 2 days and 10,000 on subsequent days. A friend of a friend got similar guidance from an MD looking into supplements for COVID.
However, the Andrew Weil Center for Integrative Medicine at University of Arizona cites concerns about inflammatory response during COVID with Vitamin D as a dietary supplement, so suggests caution with Vitamin D (see here). Coupled with my primary care doc’s concerns that it is fat soluble and can be toxic at a certain level, and internet guidance that 4,000 IU is considered the safe upper limit (per Harvard Health and HealthLine), I decided not to follow the Masterjohn recommendation here.
Vitamin C: 500 mg daily
Masterjohn recommended 2 x 200 mg daily, but my primary care doc recommended 500-1000 mg, and this is well below the safe upper limit of 2000 mg per WebMD.
Vitamin K2: 200 mcg daily.
Followed Masterjohn’s recommendation here.
Primary care doc raised concerns because she knew of no specific evidence to support this and had concerns about nausea, diarrhea, cramping, and kidney issues, but she said she didn’t know what a problematic threshold was, and Googling suggested there is no known upper limit (e.g. Metropolitan Dental Care, Futureyouhealth), so I ignored her.
Melatonin: 10mg daily
Black seed oil: 500 mg 2x daily
Listerine rinse and gargle 30 sec 2x daily
Betadine Cold Defense: 2 sprays in each nostril daily
The primary care doc raised the concern that “overdoing this could increase risk of bacterial infections”; a quick Google yielded no evidence this would happen with a week’s use, so I proceeded.
Masterjohn favors povidone-iodine, but that seems to have issues in excess, so I went with his alternative of Betadine instead.
I skipped his recommendation of eye wipes because the mechanism of action there did not seem intuitively all that strong to me vs just...washing my face / showering a couple times a day.
Note: Julia Wise recently did a deep dive on Nose / throat treatments for respiratory infections where she instead decided to do the following. Her post went up after my acute phase was over, so I have no POV on her conclusions vs Masterjohn’s.
– a spray with carrageenan or HPMC occasionally to reduce chances of catching covid at high-risk events
– carrageenan spray during the early part of a cold
– nasal washing and gargling with iodine during covid. Nasal washing seems like more of a hassle then a spray, but probably works better.
Masterjohn recommendations I did not follow:
Vitamin A: he recommends 10,000 IU daily, but that seems premised on his recommended dose of Vitamin D, which I didn’t follow. The recommended upper limit is 10,000, and the primary care doc raised vague concerns about risk of overuse, so I skipped this one.
Vitamin E: he recommends 20 IU of vitamin E, primary care doc raised similar concerns as with K2, and though 20 IU is well under what the NIH says is the upper limit, for whatever reason I decided to skip this one.
Another recommendation I did follow:
PharmEPA: 1-2g 2x daily, taken with your fattiest meals
This is from LongCovidPharmD, who I was pointed to by a friend who has no specific scientific training but has been following COVID research carefully with a high degree of caution, and was pointed to her in turn by a COVID safety Facebook group with many scientists in it. The author describes herself as a “Doctor of Pharmacy currently doing independent & informal research with a special interest in Long Covid, ME/CFS, & other post-viral conditions.” From skimming her posts they appear quite thorough, scientifically conversant, and nuanced.
I chose PharmEPA among the many other brands in her (frustratingly non-opinionated) table because in another deep-dive article she listed this as “one of the better options” and it was reasonably priced and available quickly on Amazon.
I Googled briefly and found no significant risk of side effects or interactions.
I ignored her other recommendations of Lactoferrin (because it seemed inconvenient to mix up) and EGCG (which seems to interact with Paxlovid)
This wasn’t to reduce long COVID risk; my parents (including my mother, who’s lived her whole life with asthma more severe than I have currently) raised concerns about the congestion “settling into my lungs” even though it was not particularly bothering me, so I took Robitussin 1-2x a day till my congestion was gone. My cough did occasionally reach a level where it would interrupt my sleep, so the DM part of the medication was helpful for that.
I monitored with a pulse oximeter that I bought on Amazon, 1-2x a day.
This was more to reduce the risk of my acute case taking an unexpected turn for the worse than to reduce risk of long COVID. The primary care doc cautioned that people have been reported to have dangerously low oxygen levels before they feel distress subjectively. She advised that if my readings reach the low 90s, I should reach out, and if they drop to the 80s I should go to the emergency room immediately.
I remember reading quite some time ago that if you need disability leave / insurance assistance due to long COVID, it is helpful to have a PCR test as documentation that you actually had COVID.
I am not sure whether this is still true or was ever true, but there was a free walk-in site less than a 20-min walk from my home in San Francisco, so I strolled over one day and got a test.
There’s some back and forth in the comments which suggests the study she used may be underestimating...would welcome thoughts on that. Regardless, she thinks it’s a large enough concern to continue tracking, though from her description of her and her family’s current approach to COVID in another post, not large enough to avoid indoor dining or take other significantly restrictive measures.
I have read in several places that Paxlovid is underprescribed; I’m not sure why. When my parents got COVID last fall, they asked a bunch of friends who are MDs and their consensus was that there isn’t much of an evidence base yet (the study showing impact on long COVID risk was still in preprint, though no one raised that point specifically) and it wasn’t necessary in low-severity cases. To me, the prospect of long COVID far outweighs any theoretical generic precaution about side effects (despite reading up on Paxlovid a fair amount, I haven’t seen anything even speculating that it has significant risks), so I find this odd.
I suggest making sure to get a lot of near-infrared radiation during covid and covid recovery. For most people, the sun will be the preferred source. If you don’t want at the same time to get a lot of UV light, you can wear sunscreen or high-SPF clothing and (most of) the near-infrared radiation will go right through the clothing or sunscreen.
This suggestion is supported by a RCT, summarized in this next video. Also note that the author of the video is a COVID doctor.
The RCT described in the video used LEDs to produces the near-infrared radiation, but the sun produces a lot of radiation at the same frequency. The LEDs produce all their radiation at a specific frequency whereas the sun produces radiation at all infrared frequencies, but the sun is such an intense source that even though it produces most of its radiation at the “wrong” frequencies it produces enough at the right frequencies (namely, the frequencies absorbed by the cytochrome C molecules in your mitochondria).
Interesting, hadn’t heard of that! Thanks for sharing. Looks like the video lists all of its sources in the notes below.